Closing Communication Gaps

Between Providers

June 2011

by Diane Shannon, MD, MPH

www.PerfectServe.com
(877) 844-7728

© 2011 PerfectServe, Inc.

Improving Communication among Staff:
Health Care Leaders’ Perspective
A basic tenet of the Affordable Care Act is a shift from
volume- to value-based reimbursement. Improved
coordination of care and effective communication
among health care providers are essential for success
under the new model.1 Research indicates, however,
that communication gaps in health care are common.
In 2010, communication problems were the most
commonly cited root cause of sentinel events,
according to data reported to the Joint Commission.2
Technology solutions can facilitate improved
communication and support additional improvement
initiatives. PerfectServe is a communication system
that uses workflows and contact preferences from
physician-specific algorithms to route calls and
messages according to each physician, based on
factors such as the day, time, urgency, clinical
situation, preferred contact method, and coverage
schedule. It includes integrated modules that optimize
communication between physicians and hospital staff,
physicians and other physicians, and physicians and
patients.
Health care leaders from across the country have found
that PerfectServe helps them address one of their most
pressing current needs: improved communication
among clinical staff.
Providing an effective communication tool
Lon McPherson, MD, senior vice president of Medical
Affairs and chief quality officer at Munroe Regional
Medical Center, an acute care tertiary 400-bed hospital
in the Orlando, Florida area, was accustomed to
fielding the concerns of physicians at his organization.
He recalls a particular concern brought to him
by a nephrologist: the difficulty staff experienced
when trying to contact physicians. McPherson was
familiar with PerfectServe, having been involved with
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implementation of the system at a previous position
in Chicago. After approval from the organization’s
medical executive committee (MEC), PerfectServe was
implemented enterprise-wide on a single day in May
2010.
Because physician leaders at the organization had
strongly supported the move, implementation was
a relatively smooth transition. Codifying the use of
PerfectServe in a medical staff policy approved by the
MEC optimized its uptake and use by physicians.
“He called me to say he was getting rid
of the pager he’d carried for 35 years.
Because PerfectServe routes his calls so
reliably, he no longer needs it.”
Dr. Lon McPherson
Senior VP Medical Affairs
Chief Quality Officer
Munroe Regional Medical Center
According to McPherson, PerfectServe has benefited
the hospital in several ways. First, whereas difficulty
reaching physicians was a daily occurrence prior to
implementation, it is now uncommon. “In our daily
supervisor’s report, we rarely see complaints about
contacting physicians now.”
Second, the house supervisors and the nursing staff are
now more confident that they have a reliable resource
and support for contacting physicians. Third, the noise
level at the hospital has been greatly reduced, due to
the decline in overhead paging of physicians and other
staff.
McPherson reports other changes at the organization
as well. He feels PerfectServe is helping to address
a decades-long decline in direct communication
between physicians due to increasing time pressures

and a growth in the size of the medical staff. Use of
PerfectServe supports the medical center’s policy, which
was instituted about three years ago, that requires
referring physicians to call consultants directly for any
urgent or stat consults.
Also, because PerfectServe makes the communications
process more reliable, physicians are shifting to more
efficient modes of communication.
He describes a recent discussion with a cardiologist at
the medical center. “He called me to say he was getting
rid of the pager he’d carried for 35 years. Because
PerfectServe routes his calls so reliably, he no longer
needs it.”
McPherson believes an important part of his role as a
health care leader is providing access to tools that can
effectively support physicians and other staff.
“The physician executive’s role is to be clinically savvy
enough to recognize good support tools as opposed
to mediocre or ineffective ones.” With PerfectServe,
McPherson feels he is not only providing an effective
communication tool but also working to improve
communication among physicians and other clinical
staff, and thus improving patient care.
Making direct communication the standard
of practice
A practicing obstetrician-gynecologist and chief of staff
at the 203-bed Henry Ford Macomb Hospital-Warren
campus in Michigan, Laila Shehadeh, DO, has focused
for many years on fostering direct communication
between referring physicians and consultants within
her organization.
Shehadeh sees the matter as one that is critical to
patient safety, care quality, and cost efficiency. She
would like to make direct conversations between
referring physicians and consultants the standard of
care.
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“If every physician would speak directly to the other
physicians, it would improve safety, lead to better
camaraderie, and set a good example for the residents
rotating with him or her.”
At Shehadeh’s organization, consultants are required
to address routine consults within 24 hours of the
request. She is petitioning to add the requirement that
consultants contact the referring physician.
“We now have faster communication
between the ED physician and the
consultants and admitting physicians.
We can get the patient moving through
the system faster.”
Dr. Laila Shehadeh
Chief of Staff
Obstetrics & Gynecology
Henry Ford Macomb Hospital-Warren
“I try to help physicians realize that by talking
colleague to colleague you can decrease morbidity and
mortality, lengths of stay, and sentinel events,” she says.
Like other health care leaders today, Shehadeh is
very conscious of the current scrutiny by health care
payors regarding length of stay—and the detrimental
effects of delays in communication on LOS. “Our
organizations are not going to get reimbursed for
lengths of stay that don’t meet the guidelines. We can’t
excuse a longer stay, saying ‘The patient stayed one
extra day because we couldn’t reach Dr. Shehadeh.’”
Henry Ford Macomb, Warren campus implemented
PerfectServe across the hospital in June, 2009.
According to Shehadeh, the PerfectServe system has
helped improve communication and flow in several
ways. “If I’m trying to contact the house physician, I
just dial one number and say, ‘House physician,’ and
the call goes through. Before, I had to figure out who
the current house physician was, find their beeper
number, and then call.

The turnaround time is much faster now. Plus, there
are fewer calls placed to physicians who are not
currently on call.”
As a physician leader, Shehadeh appreciates the
fact that using PerfectServe has increased the
accountability of physicians to return calls in a timely
fashion. Administrators can review a report of calls
logged from the ED and address any identified issues.
“We can approach a physician and say, ‘The ED called
you at 1:20 AM, 2:20 AM, and 3:30 AM, and you didn’t
answer.’ We had one physician who wasn’t calling back
promptly. Her patients would be ready to leave, but
the staff couldn’t contact her. Now, with PerfectServe,
we can make sure we have all the relevant contact
information—before we only had a pager number—
and we can document her call-back time.”
Flow through the ED has also improved, according
to Shehadeh. “We now have faster communication
between the ED physician and the consultants and
admitting physicians. Plus, the ED staff no longer
needs to keep track of the latest call schedule for the
multitude of physicians they need to contact. We can
get the patient moving through the system faster.”
Optimizing patient flow
Herbert Schumm, MD, regional vice president for
Medical Affairs at St. Rita’s Medical Center in Lima,
Ohio, a regional health system with 450 acute care
beds, has found that PerfectServe very effectively
supports the organization’s overall performance
improvement program.
Since the fall of 2010, medical center administrators
have used a process called Care Path, which is
based on the science of logistics, to improve patient
flow through the health system. “We’re working on
eliminating what we call the white space in the care
timeline—the time that provides no value to the
patient—which is a key piece for patient satisfaction.”
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Because slow physician call-backs can bottleneck
patient discharge from the ED, movement from the
ED to inpatient units, and discharge, they were an
early target for improvement. “It’s important that
the ED physicians are able to contact an admitting
or consulting physician easily and talk directly with
them.”
“I don’t think we could achieve such
rapid mobilization of our code team
and our rapid response team without
the ease and predictability we get with
PerfectServe. I can’t imagine not using
it.”
Dr. Herbert Schumm
Regional Vice President
Medical Affairs
St. Rita’s Medical Center
The organization implemented PerfectServe in
January 2005. Schumm especially likes the fact that
PerfectServe generates a comprehensive report of calls
by department, receiving physician and/or practice,
allowing him to identify any problems with lack of
responsiveness to calls.
“We know when calls are going out and when they’re
being responded to. We can identify when we’re having
difficulty with a physician who’s not returning calls
promptly,” he says.
Organizational leaders use the information to identify
and address gaps in the communication process. If a
problem is identified, leaders have an objective record
with which to begin a discussion with the relevant
physician.
Schumm cites a recent example involving a delayed
response to calls. He received a report that a physician
had failed to respond to six calls between 9:00 a.m. and
1:30 p.m. from the nursing staff regarding a patient
awaiting discharge. Schumm reviewed the PerfectServe

call logs with the physician and discovered that
there was both a problem with responsiveness and a
misunderstanding. The physician had responded to
some calls regarding another patient—and mistakenly
thought he had responded to all calls in the queue.
Schumm began ongoing monitoring of the physician
with a focused professional practice evaluation
specifically regarding call responsiveness. Correcting
these communication problems is important,
according to Schumm, because they can delay
discharge, thus disrupting patient flow through the
organization, and can lead to frustration among the
nursing staff.
Improving communication also is important for
reducing medication errors, according to Schumm.
“From a medication safety standpoint, being able
to talk directly with the physician who ordered
a medication, to confirm a dose or get questions
answered, is crucial.”
PerfectServe helps to facilitate direct conversations
between physicians and nursing or pharmacy staff—
conversations that can avert mistakes due to incorrect
or unclear orders. Another key benefit of PerfectServe,
says Schumm, is the ability to notify teams rapidly and
reliably.
The organization’s previous paging system was not
sufficiently reliable for contacting all team members
of its urgent response teams. With PerfectServe, an ED
physician can alert the cardiac team about a patient
with a STEMI by simply dialing a four-digit number
and indicating the patient’s location. PerfectServe
automatically notifies the interventional cardiologist,
the cath team, and other cath lab staff.
The medical center has achieved door-to-balloon
times for STEMIs under the 90-minute mark on 100
percent of cases for the past year and a half. “There’s
no way that we could achieve these results without
PerfectServe. I don’t think we could achieve such rapid
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mobilization of our code team and our rapid response
team without the ease and predictability we get with
PerfectServe. I can’t imagine not using it.”
Conclusion
PerfectServe helps health care leaders deal
with an issue currently of top concern: gaps in
communication among the health care providers
within their organizations. These leaders have found
that implementing PerfectServe can facilitate direct
communication among physicians and improve
physician responsiveness to calls.
They have found that PerfectServe facilitates improved
flow through the ED and the rapid deployment of
urgent response teams. Leaders also have found that
PerfectServe’s documentation and analytical tools help
them identify and address gaps in the communication
process.
PerfectServe is a technology solution that fosters
improved communication, is relatively easy to
implement, and meshes well with other performance
improvement and efficiency initiatives. It provides
health care leaders with an effective tool to support
clinical coordination, an important component of
quality care and a key objective of health reform.
References
1. Department of Health & Human Services. Account-
able care organizations: improving care coordination
for people with Medicare. Available at: http://www.
healthcare.gov/news/factsheets/accountablecar-
e03312011a.html. Accessed April 12, 2011.
2. Joint Commission on Accreditation of Healthcare
Organizations. The Sentinel Event Data Root Causes
by Event Type2004-Fourth Quarter 2010. Available at:
http://www.jointcommission.org/assets/1/18/Root_
Causes_by_Event_Type_2004-4Q2010.pdf. Accessed
February 22, 2011.